Primary care doctor says his hands are tied when it comes to helping patients with their mental health | Opinion

By Alexander Salerno

I am a primary care physician practicing in one of New Jersey’s medically underserved areas with few physicians and even fewer mental health professionals. In a recent month, my practice saw over 100 patients who showed signs of mental illness.

Your family doctor is probably the first healthcare professional to notice if you have common mental health issues, such as anxiety or depression. Recently, AHIP, the nation’s largest commercial health insurance group, released a statement expressing its commitment to improving access to mental health care. A recent study identified affordability – even more so than availability – as the main barrier to obtaining mental health care.

It is frankly more than time for that. The hurdles the insurance industry has required of your primary care provider make it difficult for them to make and act on this assessment. My own hands are often tied.

To get paid for what we do, all physicians bill insurance companies using an extensive, complicated, and sometimes contradictory list of codes known as Current Procedural Terminology, or CPT. That’s why many medical practices employ people just to do medical coding and billing. If a physician uses the wrong code, the request is denied.

It’s a problem in behavioral health because physician billing rules look like a maze with no easy way out. Mental health professionals generally rely on two codes for the initial assessment of psychiatric diagnosis. Psychiatrists, psychologists and other mental health practitioners use them all the time.

Your primary care provider, however, is not allowed to use these codes, even though your doctor is most likely to make an initial mental health diagnosis. I have been a primary care physician in my family practice practice, Salerno Medical Associates, for over 20 years. We have always needed to fill the void left by the shortage of mental health professionals. This is more true than ever after the pandemic: the shortage is expected to reach 15,000 mental health professionals by 2025, more than a third more than in 2013. I am glad that the insurance industry , through the AHIP, finally accepts this.

Family physicians are on the front lines of mental health. Some studies indicate that more than half of people in the waiting rooms of their primary care practices suffer from some form of depression that is never identified. We also know that many common medical conditions can cause or worsen depression. These include heart disease, cancer and chronic pain.

It is important. If there’s one condition that everyone and everyone is susceptible to, it’s depression. It affects people of all races, religions and socio-economic status equally. Conditions such as diabetes, high blood pressure and cancer affect different population groups more than others. But depression stalks us all, and your primary care provider is trained to notice it. She just can’t bill your insurance company easily, but maybe AHIP’s new stance will change that.

It’s as clear to medical providers as it is to patients that affordable mental health care is difficult to find. That’s partly because the insurance industry — again, the insurance industry — has reimbursed mental health care providers less than other medical specialists. However, the medical training of a psychiatrist is the same price as that of a plastic surgeon. AHIP is now committed to covering mental health equally with physical health, but for this to happen, mental health care providers must also be reimbursed fairly.

For now, however, the insurance industry is not letting internists and other primary care providers take some of the burden off mental health specialists. For example, if my primary diagnosis for a patient is depression, that insurance claim will likely be denied. Because my payment depends on a primary diagnosis of something like high cholesterol, low back pain, or constipation, doctors like me have no incentive to engage in this conversation with the patient about their behavioral health issues. Indeed, we are penalized for this. It is difficult to provide care easily and efficiently.

It is not difficult to improve the situation. A simple improvement would be to open the use of the billing code for psychiatric diagnostic assessment to front-line medical providers. If society truly believes – as it should – that there is a mental health crisis in this country, then let more professionals diagnose it. Make telehealth therapy more accessible.

Let’s take care of ourselves and get paid to do our job. Let patients get the care they can afford.

Dr. Alexander Salerno is a physician with Salerno Medical Associates, a second-generation family practice serving East Orange and Newark. He is also the founder of the Urban Healthcare Initiative Program (UHIP), a community-based healthcare and education provider.

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